(Mis)Using Pulse Oximetry : A Review of Pulse Oximetry use in Acute Care Medical Wards

Background: Nurses routinely use pulse oximetry (SpO2) monitoring equipment in acute care. Interpretation of the reading involves physical assessment and awareness of parameters including temperature, haemoglobin, and peripheral perfusion. However, there is little information on whether these clinical signs are routinely measured or used in pulse oximetry interpretation by nurses. Aim: The aim of this study was to review current practice of SpO2 measurement and the associated documentation of the physiological data that is required for accurate interpretation of the readings. The study reviewed the documentation practices relevant to SpO2 in five medical wards of a tertiary level metropolitan hospital. Method: A prospective casenote audit was conducted on random days over a three-month period. The audit tool had been validated in a previous study. Results: One hundred and seventy seven episodes of oxygen saturation monitoring were reviewed. Our study revealed a lack of parameters to validate the SpO2 readings. Only 10% of the casenotes reviewed had sufficient physiological data to meaningfully interpret the SpO2 reading and only 38% had an arterial blood gas as a comparator. Nursing notes rarely documented clinical interpretation of the results. Conclusion: The audits suggest that medical and nursing staff are not interpreting the pulse oximetry results in context and that the majority of the results were normal with no clinical indication for performing this observation. This reduces the usefulness of such readings and questions the appropriateness of performing “routine” SpO2 in this context.

Qualitative study of adversity activated development and resilience in adolescents and young adults with congenital heart disease and their parents

What is it like to have a medical condition that few people have ever heard about? How does it feel to have to question whether daily physical activities are dangerous for you, whilst you watch your friends enjoy those activities without a care? Can you imagine that you need to have a complicated heart surgery, with risks such as paralysis or death? Or even imagine facing the painful recovery period and scars after such a surgery? Then imagine that you are a child or teenager dealing with this medical condition when all your friends are simply occupied with school and normal life. Now consider that surgery has been undertaken to extend your lifespan, but the operation is so new that the long-term outcomes are just not known? All you really know is that you might have ‘surgical repairs’ to your heart and symptoms may be relieved or managed by medications or cardiac devices, but you are never going to be cured. What if you had already experienced painful, frightening, lonely and tedious hospitalisations and you were forced to put your life on hold to re-enter that situation, time and time again. This may be your life, as a Congenital Heart Disease or CHD patient. How do such patients cope and in many cases even thrive? This chapter will review current international literature regarding the medical and personal impact of CHD. Our qualitative study of the perspectives of young CHD patients and their parents contributes to the Australian story of CHD, as well as highlighting the potential for CHD related adversity to promote personal development.

Australia at the crossroads : a review of school science practical work

In Australia we are at a crossroad in science education. We have come from a long history of adopting international curricula, through to blending international and Australian developed materials, to the present which is a thoroughly unique Australian curriculum in science. This paper documents Australia’s journey over the past 200 years, as we prepare for the unveiling of our first truly Australian National Curriculum. One of the unique aspects of this curriculum is the emphasis on practical work and inquiry-based learning. This paper identifies seven forms of practical work currently used in Australian schools and the purposes aligned with each form by 138 pre-service and experienced in-service teachers. The paper explores the question “What does the impending national curriculum, with its emphasis on practical inquiry mean to the teachers now, are they ready?” The study suggests that practical work in Australian schools is multifaceted, and the teacher aligned purposes are dependent not only upon the age of the student, but also on the type of practical work being undertaken. It was found that most teachers are not ready to teach using inquiry-based pedagogy and cite lack of content knowledge, behaviour management, and lack of physical resources and availability of classroom space as key issues which will hinder their implementation of the inquiry component of Australia’s pending curriculum in science.

A study on the effects of routing symbol design on process model comprehension

Process modeling grammars are used to create models of business processes. In this paper, we discuss how different routing symbol designs affect an individual's ability to comprehend process models. We conduct an experiment with 154 students to ascertain which visual design principles influence process model comprehension. Our findings suggest that design principles related to perceptual discriminability and pop out improve comprehension accuracy. Furthermore, semantic transparency and aesthetic design of symbols lower the perceived difficulty of comprehension. Our results inform important principles about notational design of process modeling grammars and the effective use of process modeling in practice.

A systematic review of psychological interventions for excessive alcohol consumption among people with psychotic disorders

Objective: Excessive alcohol consumption is common among people with psychotic disorders. While there is an extensive literature on the efficacy of psychological treatments for excessive drinking, few studies have examined interventions addressing this issue among people with psychotic disorders. Method: Systematic searches in PubMed and PsycINFO were conducted to identify randomized controlled trials comparing manual guided psychological interventions for excessive alcohol consumption among individuals with psychotic disorders. Of the 429 articles identified, 7 met inclusion criteria. Data were extracted from each study regarding study sample characteristics, design, results, clinical significance of alcohol consumption results, and methodological limitations. Results: Assessment interviews, brief motivational interventions and lengthier cognitive behavior therapy have been associated with reductions in alcohol consumption among people with psychosis. While brief interventions (i.e., 1-2 sessions) were generally as effective as longer duration psychological interventions (i.e., 10 session) for reducing alcohol consumption, longer interventions provided additional benefits for depression, functioning and other alcohol outcomes. Conclusion: Excessive alcohol consumption among people with psychotic disorders is responsive to psychological interventions. It is imperative that such approaches are integrated within standard care for people with psychosis.

Knowledge economy market development mapping study

The knowledge economy relies on the diffusion and use of knowledge as well as its creation (Houghton and Sheenan, 2000). The future success of economic activity will depend on the capacity of organisations to transform by increasing their flexibility. In particular, this transformation is dependant on a decentralised, networked and multi-skilled workforce. To help organisations transition, new strategies and structures for education are required. Education systems need to concentrate less on specialist skills and more on the development of people with broad-based problem solving skills that are adaptable, with social and inter-personal communication skills necessary for networking and communication. This paper presents the findings of a ‘Knowledge Economy Market Development Mapping Study’ conducted to identify the value of design education programs from primary through to tertiary level in Queensland, Australia. The relationship of these programs to the development of the capacities mentioned above is explored. The study includes the collection of qualitative and quantitative data consisting of a literature review, focus groups and survey. Recommendations for the future development of design education programs in Queensland, Australia are proposed, and future research opportunities are presented and discussed.

Treatment of cannabis use among people with psychotic disorders : critical review of randomised controlled trials

There is growing and converging evidence that cannabis may be a major risk factor in people with psychotic disorders and prodromal psychotic symptoms. The lack of available pharmacological treatments for cannabis use indicates that psychological interventions should be a high priority, especially among people with psychotic disorders. However, there have been few randomised controlled trials (RCTs) of psychological interventions among this group. In the present study we critically overview RCTs of psychological and pharmacologic interventions among people with psychotic disorders, giving particular attention to those studies which report cannabis use outcomes. We then review data regarding treatment preferences among this group. RCTs of interventions within "real world" mental health systems among adults with severe mental disorders suggest that cannabis use is amenable to treatment in real world settings among people with psychotic disorders. RCTs of manual guided interventions among cannabis users indicate that while brief interventions are associated with reductions in cannabis use, longer interventions may be more effective. Additionally, RCTs reviewed suggest treatment with antipsychotic medication is not associated with a worsening of cannabis cravings or use and may be beneficial. The development of cannabinoid agonist medication may be an effective strategy for cannabis dependence and suitable for people with psychotic disorders. The development of cannabis use interventions for people with psychotic disorders should also consider patients' treatment preferences. Initial results indicate face-to-face interventions focussed on cannabis use may be preferred. Further research investigating the treatment preferences of people with psychotic disorders using cannabis is needed.

Numerical simulation of red blood cells’ motion : a review

The micro-circulation of blood plays an important role in human body by providing oxygen and nutrients to the cells and removing carbon dioxide and wastes from the cells. This process is greatly affected by the rheological properties of the Red Blood Cells (RBCs). Changes in the rheological properties of the RBCs are caused by certain human diseases such as malaria and sickle cell diseases. Therefore it is important to understand the motion and deformation mechanism of RBCs in order to diagnose and treat this kind of diseases. Although, many methods have been developed to explore the behavior of the RBCs in micro-channels, they could not explain the deformation mechanism of the RBCs properly. Recently developed Particle Methods are employed to explain the RBCs’ behavior in micro-channels more comprehensively. The main objective of this study is to critically analyze the present methods, used to model the RBC behavior in micro-channels, in order to develop a computationally efficient particle based model to describe the complete behavior of the RBCs in micro-channels accurately and comprehensively

Book review : Olivier Corten, The Law Against War

Olivier Corten’s The Law Against War is a comprehensive, meticulously-researched study of contemporary international law governing the use of armed force in international relations. As a translated and updated version of a 2008 book published in French, it offers valuable insights into the positivist methodology that underpins much of the European scholarship of international law. Corten undertakes a rigorous analysis of state practice from 1945 onwards, with a view to clarifying the current meaning and scope of international law’s prohibition on the use of force. His central argument is that the majority of states remain attached to a strict interpretation of this rule. For Corten, state practice indicates that the doctrines of anticipatory self-defence, pre-emptive force and humanitarian intervention have no basis in contemporary international law. His overall position accords with a traditional, restrictive view of the circumstances in which states are permitted to use force...

Academic wage structure by gender : the roles of peer review, performance, and market forces

We focus on understanding the role of productivity in determining wage structure differences between men and women in academia. The data arise from a pay-equity study carried out in a single Midwestern U.S. university over the 1996–7 academic year. Econometric results confirm that external market forces exert influence over both male and female salary. But peer review ratings play a significant role in male but not female earnings determination, with similar results for objective measures of research, teaching and service.

Community interventions for physical activity : the role of a new Cochrane systematic review

Introduction: Systematic reviews are essential in summarising the results of a range of research studies on a specific topic into a single report. They serve as a key source of evidence-based information to support and develop policy and practice for healthy communities. This presentation will examine a new review of community-wide strategies to increase population levels of physical activity and compare it to an earlier Community Guide Review (CGR) of Community-wide campaigns to increase physical activity which recommended community wide interventions. Methods: We registered a Cochrane Systematic Review (CSR) title, published a protocol and recently completed the review of Community-wide interventions to increase physical activity. We compared the definitions, design and findings of the CSR to the CGR. Results: The two reviews differed remarkably in their conclusions with the CGR recommending “strong evidence exists that community-wide campaigns are effective in increasing levels of physical activity”, and the new CSR stating “The body of evidence in this review does not support the hypothesis that multi-component community wide interventions effectively increase population levels of physical activity”. We observed that both reviews examined multi-component interventions as a “combined package”. Possible explanations for the different conclusions may be due to the definition of community (CSR defined community as “comprising those persons residing in a geographically defined community, such as a village, town, or city”, excluding interventions which were whole of state or country, and CGR as “a group of individuals who share one or more characteristics. The CSR utilised a logic model at various stages of the review process and explicitly defined a combination of strategies encompassed within the intervention. The CSR included 25 and CGR 10 studies, respectively. Six of the 10 studies that were included in CGR were excluded from the CSR due to issues relating to study design, intervention definition or duration. The two reviews also differ in function as the CSR seeks to summarise global evidence and included 7 studies in low-income countries, where as the CGR contained only studies deemed relevant to the USA context. Discussion: Differences in the findings between older and newer reviews can be due to a variety of factors. For example, in updating a review the definition of an intervention can be changed. Further, differences may also be due to improvements in the standards and methodologies for systematic reviews as well as the inclusion of newer studies. These factors need to be understood whenever differences between newer and older reviews are considered.

Methodological challenges in conducting a systematic review of community wide interventions to increase physical activity

Introduction: Evaluating the effectiveness of interventions designed to increase the physical activity in communities is often a difficult and complex task, requiring considerable expertise and investment, and often constrained by methodological limitations. These limitations, in turn, create additional challenges when these studies are used in systematic reviews as they hinder the confidence, precision and interpretation of results. The objective of this paper is to summarise the methodological challenges posed in conducting a systematic review of community-wide physical activity interventions to help inform those conducting future primary research and systematic reviews. Methods: We conducted a Cochrane systematic review of community-wide interventions to increase physical activity. We assessed the methodological quality of the included studies. We will investigate these in greater detail, particularly in relation to the potential impact on measures of effect, confidence in results, generalizability of results and general interpretation. Results: The systematic review was conducted and has been published in the Cochrane Library. A logic model was helpful in defining and interpreting the studies. Many studies of unsuitable study design were excluded; however several important methodological limitations of the primary studies evaluating community-wide physical activity interventions emerged. These included: - the failure to use validated tools to measure physical activity; - issues associated with pre and post test designs; - inadequate sampling of populations; - poor control groups; and - intervention and measurement protocols of inadequate duration. Although it is challenging to undertake rigorous evaluations of complex interventions, these issues result in significant uncertainty over the effectiveness of these interventions, and the possible factors required for a community-wide intervention to be successful. In particular, the combination of several of these limitations (e.g. un-validated tools, inadequate sampling, and short duration) is that studies may lack the sensitivity to detect any meaningful change. Multiple publications of findings for the same study also made interpretation difficult; however, interventions with parallel qualitative publications were helpful. Discussion: Evaluating community wide interventions to increase physical activity in a rigorous way is incredibly challenging. These findings reflect these challenges but have important ramifications for researchers conducting primary studies to determine the efficacy of such interventions, as well as for researchers conducting systematic reviews. This new review shows that the inadequacies of design and evaluation are continuing. It is hoped that the adoption of such suggestions may aid in the development of systematic reviews, but more importantly, in enabling translation of such findings into policy and practice.

The borate mineral jeremejevite Al6(BO3)5(F,OH)3 – A vibrational spectroscopic study

Jeremejevite is a borate mineral of aluminium and is of variable colour, making the mineral and important inexpensive jewel. The mineral contains variable amounts of F and OH, depending on origin. A comparison of the vibrational spectroscopic data is made with the published data of borate minerals. Raman spectra were averaged over a range of crystal orientations. Two intense Raman bands observed at 961 and 1067 cm−1 are assigned to the symmetric stretching and antisymmetric stretching modes of trigonal boron. Infrared spectrum, bands observed at 1229, 1304, 1350, 1388 and 1448 cm−1 are attributed to BOH in-plane bending modes. Intense Raman band found at 372 cm−1 with other bands of significant intensity at 327 and 417 cm−1 is assigned to trigonal borate bending modes. A quite intense Raman band is found at 3673 cm−1 with other sharp Raman bands found at 3521, 3625 and 3703 cm−1 are assigned to the stretching modes of OH. Raman and infrared spectroscopy has been used to assess the molecular structure of the mineral jeremejevite. Such research is important in the study of borate based nanomaterials.

Games for change and transformative learning : an ethnographic case study

This thesis aims to contribute to a better understanding of how serious games/games for change function as learning frameworks for transformative learning in an educational setting. This study illustrates how the meaning-making processes and learning with and through computer gameplay are highly contingent, and are significantly influenced by the uncertainties of the situational context. The study focuses on SCAPE, a simulation game that addresses urban planning and sustainability. SCAPE is based on the real-world scenario of Kelvin Grove Urban Village, an inner city redevelopment area in Brisbane, Queensland, Australia. The game is embedded within an educational program, and I thus account for the various gameplay experiences of different school classes participating in this program. The networks emerging from the interactions between students/players, educators, facilitators, the technology, the researcher, as well as the setting, result in unanticipated, controversial, and sometimes unintended gameplay experiences and outcomes. To unpack play, transformative learning and games, this study adopts an ecological approach that considers the magic circle of gameplay in its wider context. Using Actor-Network Theory as the ontological lens for inquiry, the methods for investigation include an extensive literature review, ethnographic participant observation of SCAPE, as well as student and teacher questionnaires, finishing with interviews with the designers and facilitators of SCAPE. Altogether, these methods address my research aim to better understand how the heterogeneous actors engage in the relationships in and around gameplay, and illustrate how their conflicting understandings enable, shape or constrain the (transformative) learning experience. To disentangle these complexities, my focus continuously shifts between the following modes of inquiry into the aims „h To describe and analyse the game as a designed artefact. „h To examine the gameplay experiences of players/students and account for how these experiences are constituted in the relationships of the network. „h To trace the meaning-making processes emerging from the various relations of players/students, facilitators, teachers, designers, technology, researcher, and setting, and consider how the boundaries of the respective ecology are configured and negotiated. „h To draw out the implications for the wider research area of game-based learning by using the simulation game SCAPE as an example for introducing gameplay to educational settings. Accounting in detail for five school classes, these accounts represent, each in its own right, distinct and sometimes controversial forms of engagement in gameplay. The practices and negotiations of all the assembled human and non-human actors highlight the contingent nature of gameplay and learning. In their sum, they offer distinct but by no means exhaustive examples of the various relationships that emerge from the different assemblages of human and non-human actors. This thesis, hence, illustrates that game-based learning in an educational setting is accompanied by considerable unpredictability and uncertainty. As ordinary life spills and leaks into gameplay experiences, group dynamics and the negotiations of technology, I argue that overly deterministic assertions of the game¡¦s intention, as well as a too narrowly defined understanding of the transformative learning outcome, can constrain our inquiries and hinder efforts to further elucidate and understand the evolving uncertainties around game-based learning. Instead, this thesis posits that playing and transformative learning are relational effects of the respective ecology, where all actors are networked in their (partial) enrolment in the process of translation. This study thus attempts to foreground the rich opportunities for exploring how game-based learning is assembled as a network of practices.

Peer assisted learning, skills development and Generation Y : a case study of a first year undergraduate law unit

The majority of current first year university students belong to Generation Y. Consequently, research suggests that, in order to more effectively engage them, their particular learning preferences should be acknowledged in the organisation of their learning environments and in the support provided. These preferences are reflected in the Torts Student Peer Mentor Program, which, as part of the undergraduate law degree at the Queensland University of Technology, utilises active learning, structured sessions and teamwork to supplement student understanding of the substantive law of Torts with the development of life-long skills. This article outlines the Program, and its relevance to the learning styles and experiences of Generation Y first year law students transitioning to university, in order to investigate student perceptions of its effectiveness – both generally and, more specifically, in terms of the Program’s capacity to assist students to develop academic and work-related skills.